Dr. Vaidya’s Review (June 2025)
Published in JAMA, this review by Anand Vaidya—an endocrinologist at Harvard University and Director of the Adrenal Center at Brigham and Women’s Hospital—offers a clear overview of adrenal insufficiency. The paper, “Adrenal Insufficiency in Adults: A Review,” divides the condition into three main types: primary, secondary, and glucocorticoid-induced. It also offers detailed, data-supported explanations of how recovery occurs and how to safely taper medication. This article is especially useful for understanding one’s treatment and long-term management.
DHEA-S as a Possible Biomarker (February 2025)
The medical news site Healio reported in “DHEA-S may serve as biomarker for diagnosing adrenal insufficiency” that blood levels of DHEA-S (dehydroepiandrosterone sulfate) may help detect adrenal insufficiency earlier. When cortisol and ACTH levels are combined with DHEA-S, a low DHEA-S value may suggest reduced adrenal reserve and could help identify early dysfunction before symptoms worsen.
Europe and the US Guideline for Glucocorticoid-Induced Adrenal Insufficiency (May 2024)
This joint guideline from the European Society of Endocrinology and the Endocrine Society, published as “Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency,” outlines how glucocorticoid-induced adrenal insufficiency should be evaluated and managed. It covers key points such as the basic approach to tapering steroids, using morning cortisol to assess HPA-axis recovery, and understanding that inhaled, topical, and intra-articular steroids can also cause suppression. For those with reversible adrenal insufficiency, it provides helpful context and a clear framework for organizing treatment decisions.
Professor Hindmarsh’s Textbook (March 2024)
The book Replacement Therapies in Adrenal Insufficiency by Peter C. Hindmarsh, Professor of Pediatric Endocrinology at University College London Hospitals, and Kathy Geertsma, a patient advocate, is widely discussed among medical professionals. It explains causes, treatment methods, drug interactions, and emergency care for conditions such as Addison’s disease, hypopituitarism, congenital adrenal hypoplasia, and adrenalectomy. Based on decades of experience, the book offers a practical guide to fine-tuning hormone replacement therapy.
Japanese Guideline for ACTH Deficiency (2023)
The Japan Endocrine Society updated its “Guidelines for the Diagnosis and Treatment of Hypothalamic-Pituitary Disorders” in 2023, revising the section on ACTH deficiency. It recommends excluding the effects of any steroid use, including inhalers and eye drops, during diagnosis. For treatment, hydrocortisone should start at 5–10 mg per day, with follow-up every 1–2 weeks. The guideline also warns that doses above 20 mg per day may increase health risks, suggesting a safe range of 5–20 mg daily.
Gradual Dose Reduction in Replacement Therapy (June 2023)
The study “Daily Glucocorticoid Replacement Dose in Adrenal Insufficiency” explains how to find a realistic dose that prevents both under- and over-replacement. It suggests customizing the dose based on body weight, metabolism, activity level, inflammation, and stress response. For mild or partial secondary adrenal insufficiency, very low maintenance doses (0–10 mg/day) may be enough, emphasizing the need for flexible and personalized treatment plans.
Dr. Husebye’s Review (February 2021)
Many current guidelines are based on studies of primary adrenal insufficiency, often using only on body weight or surface area to calculate doses. However, researchers like Eystein S. Husebye at the University of Bergen in Norway have suggested more refined approaches. His paper “Adrenal Insufficiency” (2021) discusses both primary and secondary forms of the condition and has influenced updated clinical practices. The full article is available for purchase online (USD $39.95 + tax).
Exercise and Cortisol Supplementation (October 2015)
The study “Effect of a Pre-Exercise Hydrocortisone Dose on Short-Term Physical Performance” tested whether taking hydrocortisone before exercise improves performance in women with Addison’s disease. It found no significant benefit—in fact, cortisol levels tended to drop more after exercise when an extra dose was taken. For short workouts, maintaining good nutrition and stable energy may be more effective than increasing hydrocortisone beforehand.
Inhaled Steroids and Adrenal Suppression (2015–2021)
A Reuters report, “Common asthma steroids linked to side effects in adrenal glands,” describes adrenal suppression linked to inhaled corticosteroids, especially fluticasone. Another study, “Inhaled corticosteroid related adrenal suppression detected by poor growth and reversed with ciclesonide,” found that switching to ciclesonide (Alvesco) reversed growth delays in children. Since ciclesonide becomes active only in the lungs, it results in less systemic exposure and milder effects on the HPA axis.
Predicting HPA-Axis Recovery (May 2018)
The study “The Short Synacthen (Corticotropin) Test Can Be Used to Predict Recovery of Hypothalamo-Pituitary-Adrenal Axis Function” looked at whether ACTH stimulation test results could predict recovery in patients with reversible adrenal insufficiency. The baseline and 30-minute cortisol levels, as well as the increase (delta cortisol), were found to help predict which patients would regain normal adrenal function.
Hydrocortisone 10 mg Absorption Study (September 2015)
A Japanese Endocrine Society report “Vol. 91 Suppl. Sep. 2015” measured how cortisol levels change after taking 10 mg of hydrocortisone. On an empty stomach, cortisol peaked around 36 µg/dL, while after a meal the rise was slower and more stable. The findings suggest that meal timing significantly affects absorption and blood levels.
Finding the Optimal Replacement Dose (April 2008)
A review in the Journal of the Japanese Society of Internal Medicine, “Diagnosis and Treatment of Adrenal Insufficiency,” noted that common Japanese doses (20 mg for primary AI, 15–20 mg for secondary) are slightly higher than necessary. Ideally, doses should be based on body weight and natural hormone rhythms, but current formulations make this difficult. The authors hope for future therapies that better match the body’s daily rhythm.
Drugs and Nutrients that Affect Cortisol (March 2008)
According to “Drugs and HPA Axis” (Ambrogio AG et al., 2008) and Dr. Friedman’s summary “Drugs and Cortisol,” many medications and supplements can increase or decrease cortisol levels by affecting the enzyme CYP3A4 or binding proteins like CBG. When starting or adjusting steroid therapy, it’s important to review all other medications and supplements to avoid unexpected interactions.